切除不能肝転移を有する大腸癌症例に対しFOLFOX療法施行後, 切除可能となった2例 Two Cases of Colon Cancer with Unresectable Liver Metastases Successfully Resected after FOLFOX Therapy

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著者

    • 須藤 剛 SUTO T.
    • 山形県立中央病院外科 Department of Gastroenterological Surgery, Yamagata Prefectual Central Hospital
    • 池田 栄一 IKEDA E.
    • 山形県立中央病院外科 Department of Gastroenterological Surgery, Yamagata Prefectual Central Hospital
    • 高野 成尚 TAKANO N.
    • 山形県立中央病院外科 Department of Gastroenterological Surgery, Yamagata Prefectual Central Hospital
    • 佐藤 敏彦 SATO T.
    • 山形県立中央病院外科 Department of Gastroenterological Surgery, Yamagata Prefectual Central Hospital

抄録

切除不能肝転移を有する大腸癌症例に対し,原発巣切除後FOLFOX4療法を施行し,肝切除し得た2症例を経験した.症例1は74歳女性.盲腸癌多発肝転移例に原発巣と肝外側区域切除後,FOLFOX4療法11コース施行し残肝腫瘍縮小効果65%にて肝右葉前区,背側区,後区域切除術施行.症例2は41歳女性.S状結腸癌多発肝転移例に5Fuを肝動注療法としたFOLFOX4療法9コース施行し,腫瘍縮小効果56%にて肝右葉切除術施行.さらにFOLFIRI3コース後に残存腫瘍摘出術施行した.両症例ともに化学療法後のPET/CTでは異常集積を認めなかったが,病理組織学的検査では残存細胞を認めた.切除不能肝転移症例に対する化学療法は延命を目的としたものが主であったが,最近では奏効率の高い全身化学療法を併用し根治切除が可能となりつつある.今後は最も適した切除時期を見極めつつ,切除後の補助化学療法も含めた集学的治療により切除不能肝転移症例の生存率の向上につながると思われる.<br>

We encountered two patients with colon cancer and unresectable liver metastases, who underwent hepatectomy after FOLFOX4 therapy following resection of the primary lesion. Patient 1 was a 74-year-old woman with cecal cancer and multiple liver metastases. She underwent resection of the primary tumor and lateral segmentectomy of the liver followed by 11 courses of FOLFOX4 therapy. When a 65% reduction in the size of the residual tumor was achieved, she underwent a right anterior dorsal segmentectomy. Patient 2 was a 41-year-old woman with sigmoid colon cancer and multiple liver metastases, who received nine courses of modified FOLFOX4 therapy involving hepatic arterial infusion of 5-FU. When a 56% reduction in tumor size was achieved, she underwent a right hepatic lobectomy, followed by three courses of FOLFIRI therapy and subsequent resection of the residual tumor. Neither patient showed abnormal uptake on post-chemotherapeutic PET/CT images, but histopathological examination revealed residual tumor cells. The combined use of surgery and a highly effective systemic chemotherapy regimen allows curable resection. Determining the optimal timing of tumor resection and performing multimodal therapy including post-resection adjuvant chemotherapy will lead to an improvement in the survival rate of patients with unresectable liver metastases.<br>

収録刊行物

  • 日本大腸肛門病学会雑誌  

    日本大腸肛門病学会雑誌 61(5), 260-266, 2008-05-01 

    The Japan Society of Coloproctology

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